For hours on end, the small group of British Columbia researchers sat in a
darkened room, repeatedly watching videotapes of the circumcisions of 10
baby boys.

As they observed the three video screens before them, the researchers
systematically noted and itemized the behaviour they witnessed, assigning
each head twitch, each leg kick, each eye squeezing, one of more than 230 designated codes on a scale meant to scientifically classify the infants'
distress-related behaviour.

For lead researcher Fay Warnock, a professor at the University of British
Columbia's School of Nursing, this kind of detailed data collection meant
exhaustive and successive viewing of each of these 90-minute tapes on a
second-by-second basis.

Dr. Warnock says her work "is very basic in that it is focused on
detailing normally occurring newborn pain-related distress behaviours.... Its
usefulness is conceptual and, hopefully, will result in a deeper and more
comprehensive descriptive understanding of newborn pain expression."

She says the study focused on circumcision because it is "an intense form of newborn acute pain," but stressed that further research in this area requires ongoing descriptions of other kinds of acute pain.

While impassioned debates about the pros and cons of circumcision continue unabated in living rooms and medical offices across the country, Dr.
Warnock and her researchers stared at the loop of images for days on end, intently scrutinizing the most minute responses.

For the purposes of the study, each of the baby's anatomical regions
(head, upper torso, upper extremities, etc.) was viewed in successive order and
the videotape was run at fast-forward speed to identify further changes and
any natural clustering in behaviours. Speeding up the tape and playing up to
three videotapes concurrently also made it easier to identify when, and under
what circumstances, certain behaviours occurred together and in all babies.

The equipment allowed the researchers to monitor the screens at a pace of
30 frames per second, but the observation process actually meant it took a
skilled rater about 2 1/2 hours to code a single minute of videotaped
data.

In the end, all of these minute observations were compiled to create an
exhaustive behavioural scientific listing, or ethogram, of neonatal
distress behaviour in response to acute pain.

The completed ethogram, outlined this year in a paper in the journal
Infant Behaviour & Development, is an eight-page roster of various motor
movements, positionings, respirations and vocalizations. In this format, the quality
of each baby's body movement fits one of seven categories, ranging from nil
to frantic to tremulous, jerky and unco-ordinated; respiration is further
classified in one of 15 ways, including grunt, gasp, gag, hiccup, catching and rapid inspiration.

Dr. Warnock says this preliminary ethogram showed a wide range of distress
behaviours that can be easily and reliably identified, including some
responses previously unidentified by researchers, such as: gasping and
breath-holding; exaggerated shift-like movements of the upper torso; strained downward movements of the shoulders; and flailing, frantic movements of the upper and lower extremities.

She is quick to say this research, though fascinating, has no immediate or
direct practical benefit because it represents descriptive, conceptual
information about a single instance of pain - circumcision.

[One direct practical benefit would be if people recognised that the simplest method of avoiding this pain is not to circumcise.]

"Because my work is basic, it cannot be interpreted at this stage to be
clinically applicable.... The aim was to add to pain behaviour knowledge
simply by describing behaviours about which we know little."

There is something Mengele-like about being able to watch these tapes in such detail and not becoming a dedicated opponent of circumcision.

The aim of this basic observational study was to initiate development
of a reliable ethogram of neonatal distress-related pain behavior.
The videotapes of 10 full-term male newborns were observed repeatedly
and systematically to inductively generate an exhaustive and
structured listing of behavior. All 10 neonates were 72 hours of age
or less, and all underwent the same distress-inducing events associated with newborn male circumcision. The reliably established
ethogram contained 235 molecular and molar items for describing
variation in neonatal motor movement, body postures, responsiveness,
self-comfort, respiration, and vocalization. Also included were items
for describing three distress-provoking stimuli: ambient sound,
procedure-related stimuli, and innate responses made by the neonates.
Novel descriptions contained in the ethogram extend knowledge of how
neonates respond behaviorally to pain and non-pain situations. In
combination with existing knowledge, they provide the descriptive
prerequisites needed to distinguish newborn pain and the basis for
further investigating important but poorly understood topics, such as
newborn ability to self-organize or recover from significant exposure
to pain and stress.